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12/13/2011 TUB 16:23 PAX <br />Ljc0110n <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />10S1L-f_'�R° T) S� <br />PROJECT ADDRESS <br />RoPaERT t11t,+, logi�l 3R� p►�Sf_EvER i WA 9�Zo� HZS 8'70 -7V. <br />Owner Mail Address Cly statc!zq: Phone <br />Tenant Mail Address City Stole/zip I'hcm! <br />5YouwlStl,LZC'2lG BLS S STAr,%j 7r SEA-rTLIr I41 61WO Zo�•�93-252! <br />Electrical Contractor Mail Address City Slatelzip <br />AS i)uYW ri2S..�oa0 <br />State License Number Contract Price of Work <br />(-eSjC)ev.0 e- Sect--, ►')1cr- C-P;c� <br />Proposed Use of Building Contact Person (Plan Review) <br />Description of Work to Be Done: huhY�i r�� oW 0U /r)Ur4 C.i dCv�T 171rYl,Sp�i� <br />ss coil <br />NOTE: WIRING IN NON -DWELLINGS IS REQUIRED TO FEL <br />BE IN RACEWAYS, MC OR AC CABLE. r D / O0 <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 J <br />I hereby certify that I have read and examined this application and know the same to be true and <br />correct. All provisions of laws and ordinances goveming this type of work will be completed O� <br />whether specified heroin or not. The granting of permit does not presume to give authority to { I <br />violate or cancel the provisions of any other state or local law regulating construction or file <br />performance of construction. That I am authorized by the owner of this property to perform Ilia <br />work for whlc ' n is made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 W <br />12lI ) <br />Signature Dale <br />